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Change Motivation Worksheet

Change Motivation Worksheet

What are your long-term goal(s)?
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If you have listed more than one goal, please pick the one that you would most like to tackle first.
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List the three things in your life that are most important to you.
1.____________________________________________________________________________
2.____________________________________________________________________________
3.____________________________________________________________________________

How would making this change improve your ability to nurture these three things?
1. ____________________________________________________________________________
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2. ____________________________________________________________________________
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3. ____________________________________________________________________________
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Take a few moments to picture the “new you.” How will this person differ from the person that
you are today?
Physically:______________________________________________________________________
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______________________________________________________________________________ Mentally:_______________________________________________________________________
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Emotionally: ___________________________________________________________________
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Take either yesterday or today as an example. How would your day have gone differently if you
would have already made the change that you are currently contemplating?
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What are you most afraid of as you embark on this new journey?

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What could you do to prevent these fears from becoming a reality?
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List three to five specific and measurable short-term goals that will help you to achieve your
 long-term goal. Include the date by which you would like to achieve each goal (ie, exercising for
30 minutes/day or cutting out bedtime snacks). 
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Which of these changes do you think you will find the easiest to achieve, and which will rank as
the hardest?

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List one to three other difficult things that you have achieved in your lifetime. Did you learn any
lessons during these times that you could apply to your current challenge?
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List five ways that you could keep yourself motivated on especially hard days.
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How will you reward yourself when you reach your short-term goals? What about when you have
 achieved your long-term goal(s)?
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Do you talk to yourself like a friend would? If not, write below what sort of cruel things you say
to yourself.
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Now, turn every one of those statements around. What would you say if someone said those
same comments to you about someone you care about?
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Would any material things make this time easier for you? Examples might include new exercise
clothes or a vegetable steamer. 
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Who will you call for support when you are having a tough time sticking to your plan?
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Review Date 3/09
G-0978

 

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